A longitudinal study of pre- and post-weaning tail damage in non-docked pigs.

Tail-biting occurs pre-weaning, but literature on tail damage during lactation and on the development of damage over time is sparse, especially for non-docked piglets. We assessed the prevalence of tail damage in non-docked piglets in a commercial Danish piggery during the lactation and weaning period, and investigated the within-animal association of tail lesions pre- and post-weaning. Non-docked piglets (n = 741) from 51 loose-housed sows were individually marked and tracked from birth to 9 weeks (w9) of age. Tail damage was scored during lactation at w1 and w4, and once a week post-weaning (average weaning age 30 days) at w6 to w9. The within-animal association of tail damage before and after weaning was investigated at pig level using generalized mixed models. Tail damage was prevalent already pre-weaning. During the lactation period, the prevalence of tail lesions was 5% at w1 and 42% at w4, with the most prevalent score being 'superficial damages' (66.7%, score 1; pre-weaning scheme: 0 = no damage, 3 = tail wound). Post-weaning, 45% of pigs had a tail lesion at least once over the four assessments, with 16.7% of pigs having a tail lesion at least at two assessments. The majority of lesions were 'minor scratches' (34.2%, score 1; post-weaning scheme: 0 = no damage, 4 = wound - necrotic tail end) and a 'scabbed wound' (19.9%, score 3). The number of pigs with lesions as well as wound severity increased over time. More pigs had a tail wound at w8 (15%, P < 0.001 and < 0.01) and w9 (19%, P < 0.001 and < 0.001) compared to w6 (2.7%) and w7 (5.6%). Pigs with tail lesions pre-weaning (w1: OR 3.0, 95% CI 0.9 to 10.2; w4: OR 3.4, 95% CI 2.0 to 5.8) had a significantly higher risk of having a wound post-weaning, and pigs with lesions at w4 additionally were at a higher risk (OR 3.0, 95% CI 1.8 to 5.1) of having a lesion over several assessments. Females compared to castrated males had a significantly lower risk of having tail lesions at w1 (OR 0.3, 95% CI 0.1 to 0.8). Similarly, females were at a significantly lower risk (OR 0.5, 95% CI 0.4 to 0.9) of having a wound post-weaning, and tended to have a lower risk of having lesions over several assessments (OR 0.7, 95% CI 0.5 to 1.2). Our study confirmed that tail damage is prevalent already during the lactation period, and that pre-weaning tail damage is predictive of tail wounds post-weaning.

Effect of pen design on tail biting and tail-directed behaviour of finishing pigs with intact tails.

Tail biting is a welfare and economical concern in modern pig production. One common preventive measure used throughout the world is tail docking, which is generally considered one of the most effective methods for limiting tail biting. However, tail docking is a painful mutilation and systematic tail docking is not allowed in the EU. Therefore, the aim was to compare pig behaviour and the prevalence of tail biting in finishing pigs with intact tails housed in two different pen designs under Danish commercial conditions. PEN1 was a traditional Danish pen and PEN2 was inspired by Swedish finisher pen design and had a larger proportion of solid floor area (PEN1: 1/3 and PEN2: 2/3), reduced group size (PEN1: 15 and PEN2: 12), increased space allowance per head (PEN1: 0.7 m2 and PEN2: 0.89 m2) and straw allocated on the floor (PEN2) whereas straw was provided in a straw rack in PEN1. Tail damage observations were carried out daily by the stockperson and every 2 weeks one trained research technician assessed tail damages according to a tail scoring system. Tail lesions were observed in 51% of PEN1 and in 11% of PEN2 (P < 0.001). PEN1 had higher prevalence of tail damages than PEN2 (23% v. 5%, P < 0.001). Behavioural observations were carried out by the use of video recordings. Pigs in PEN2 tended to spend more time on tail-directed behaviour than pigs in PEN1 (P = 0.07), whereas pigs in PEN1 tended to spend more time on ear-directed behaviour (P = 0.08). Pigs in PEN2 spent more time on straw-directed behaviour compared to pigs in PEN1 (P < 0.001). Pen design did not affect time spent on other penmate-directed behaviour. In addition, the level of welfare between the two pen designs was compared using the Welfare Quality® protocol. PEN2 received an overall score of 'excellent' while PEN1 scored 'enhanced'. PEN2 scored higher on all principles besides 'good health', where PEN1 scored better on lameness and wounds. The main measurements accounting for the differences were water supply, huddling, tail biting, social behaviour and fear of humans. In conclusion, the combination of increased space allowance, increased area of solid flooring, straw allocated onto the floor and reduced group size (PEN2) resulted in fewer tail damaged pigs and a better overall welfare assessment, despite a tendency for more tail-directed behaviour.

More tail lesions among undocked than tail docked pigs in a conventional herd.

The vast majority of piglets reared in the European Union (EU) and worldwide is tail docked to reduce the risk of being tail bitten, even though EU animal welfare legislation bans routine tail docking. Many conventional herds experience low levels of tail biting among tail docked pigs, however it is not known, what the prevalence would have been had the pigs not been tail docked. The aim of this study was to compare the prevalence of tail lesions between docked and undocked pigs in a conventional piggery in Denmark with very low prevalence of tail biting among tail docked pigs. The study included 1922 DanAvl Duroc×(Landrace×Large White) female and castrated male pigs (962 docked and 960 undocked). Docked and undocked pigs were housed under the same conditions in the same room but in separate pens with 20 (±0.03) pigs/pen. Pigs had ad libitum access to commercial diets in a feed dispenser. Manipulable material in the form of chopped straw was provided daily on the floor (~10 g/pig per day), and each pen had two vertically placed soft wood boards. From weaning to slaughter, tail wounds (injury severity and freshness) were scored every 2nd week. No clinical signs of injured tails were observed within the tail docked group, whereas 23.0% of the undocked pigs got a tail lesion. On average, 4.0% of the pigs with undocked tails had a tail lesion on tail inspection days. More pens with tail lesions were observed among pigs weighing 30 to 60 kg (34.3%; P<0.05) than in pens with pigs weighing 7 to 30 kg (13.0%) and 60 to 90 kg (12.8%). Removal of pigs to a hospital pen was more likely in undocked pens (P<0.05, 47.7% undocked pens and 22.9% docked pens). Finally, abattoir meat inspection data revealed more tail biting remarks in undocked pigs (P<0.001). In conclusion, this study suggests that housing pigs with intact tails in conventional herds with very low prevalence of tail biting among tail docked pigs, will increase the prevalence of pigs with tail lesions considerably, and pig producers will need more hospital pens. Abattoir data indicate that tail biting remarks from meat inspection data severely underestimate on-farm prevalence of tail lesions.

The effect of long or chopped straw on pig behaviour.

In the EU, pigs must have permanent access to manipulable materials such as straw, rope, wood, etc. Long straw can fulfil this function, but can increase labour requirements for cleaning pens, and result in problems with blocked slatted floors and slurry systems. Chopped straw might be more practical, but what is the effect on pigs' behaviour of using chopped straw instead of long straw? Commercial pigs in 1/3 slatted, 2/3 solid pens of 15 pigs were provided with either 100 g/pig per day of long straw (20 pens) or of chopped straw (19 pens). Behavioural observations were made of three focal pigs per pen (one from each of small, medium and large weight tertiles) for one full day between 0600 and 2300 h at each of ~40 and ~80 kg. The time spent rooting/investigating overall (709 s/pig per hour at 40 kg to 533 s/pig per hour at 80 kg), or directed to the straw/solid floor (497 s/pig per hour at 40 kg to 343 s/pig per hour at 80 kg), was not affected by straw length but reduced with age. Time spent investigating other pigs (83 s/pig per hour at 40 kg), the slatted floor (57 s/pig per hour) or pen fixtures (21 s/pig per hour) was not affected by age or straw length. Aggressive behaviour was infrequent, but lasted about twice as long in pens with chopped straw (2.3 s/pig per hour at 40 kg) compared with pens with long straw (1.0 s/pig per hour at 40 kg, P=0.060). There were no significant effects of straw length on tail or ear lesions, but shoulders were significantly more likely to have minor scratches with chopped straw (P=0.031), which may reflect the higher levels of aggression. Smaller pigs showed more rooting/investigatory behaviour, and in particular directed towards the straw/solid floor and the slatted floor than their larger pen-mates. Females exhibited more straw and pen fixture-directed behaviour than males. There were no effects of pig size or sex on behaviour directed towards other pigs. In summary, pigs spent similar amounts of time interacting with straw/solid floor when long and chopped straw were provided, and most aspects of pig-directed behaviour and injuries were not affected by straw length. There was an increase in pigs with minor shoulder lesions with chopped straw, perhaps because of increased aggression. The use of chopped straw as an enrichment material for pigs warrants further investigation in larger and more detailed studies.

Injurious tail biting in pigs: how can it be controlled in existing systems without tail docking?

Tail biting is a serious animal welfare and economic problem in pig production. Tail docking, which reduces but does not eliminate tail biting, remains widespread. However, in the EU tail docking may not be used routinely, and some 'alternative' forms of pig production and certain countries do not allow tail docking at all. Against this background, using a novel approach focusing on research where tail injuries were quantified, we review the measures that can be used to control tail biting in pigs without tail docking. Using this strict criterion, there was good evidence that manipulable substrates and feeder space affect damaging tail biting. Only epidemiological evidence was available for effects of temperature and season, and the effect of stocking density was unclear. Studies suggest that group size has little effect, and the effects of nutrition, disease and breed require further investigation. The review identifies a number of knowledge gaps and promising avenues for future research into prevention and mitigation. We illustrate the diversity of hypotheses concerning how different proposed risk factors might increase tail biting through their effect on each other or on the proposed underlying processes of tail biting. A quantitative comparison of the efficacy of different methods of provision of manipulable materials, and a review of current practices in countries and assurance schemes where tail docking is banned, both suggest that daily provision of small quantities of destructible, manipulable natural materials can be of considerable benefit. Further comparative research is needed into materials, such as ropes, which are compatible with slatted floors. Also, materials which double as fuel for anaerobic digesters could be utilised. As well as optimising housing and management to reduce risk, it is important to detect and treat tail biting as soon as it occurs. Early warning signs before the first bloody tails appear, such as pigs holding their tails tucked under, could in future be automatically detected using precision livestock farming methods enabling earlier reaction and prevention of tail damage. However, there is a lack of scientific studies on how best to respond to outbreaks: the effectiveness of, for example, removing biters and/or bitten pigs, increasing enrichment, or applying substances to tails should be investigated. Finally, some breeding companies are exploring options for reducing the genetic propensity to tail bite. If these various approaches to reduce tail biting are implemented we propose that the need for tail docking will be reduced.

Behaviour of liquid-fed growing pigs provided with straw in various amounts and frequencies.

Straw possesses many characteristics that make it attractive to pigs and can therefore be effective in preventing negative penmate-directed behaviours. However, straw is difficult to handle in current vacuum slurry systems under most commercial conditions and can therefore only be used in limited amounts. To occupy pigs effectively, straw must remain attractive to pigs throughout the whole day; hence, have a certain degree of novelty. We investigated the penmate-directed behaviour of liquid-fed growing pigs in a production herd, assigned to five experimental treatments: 1×25, 1×50, 1×100, 2×50 and 4×25 g of chopped straw/pig per day, with 20 replicates of each treatment (pen was regarded as experimental unit). Behaviour was observed at two different growth stages; ~40 and 80 kg live weight of the pigs. Activity and exploratory behaviour directed at penmates, straw, pen components and the slatted floor were registered continuously for 15 min of each hour during day time (0600 to 2200 h) by use of video observation of three focal pigs per pen. The pigs were active for about one-third of the day corresponding to ~5 h/day. Of the active time, an average of 7% (35 min) was spent on penmate-directed behaviour. The pigs were more active and increased their straw-directed behaviour when provided with 100 g straw/pig per day compared with 25 and 50 g (P<0.001). However, penmate-directed behaviour was not reduced with an increased amount of straw (P>0.05), and there was no effect on pigs' behaviour when straw provision was increased per day (P>0.05). Pigs became less active and reduced their straw-directed activities when their weight increased from 40 to 80 kg live weight (P<0.001), but the amount of penmate-directed behaviour was similar (P>0.05). Further, the residual straw results indicated that perhaps a more frequent straw provision could help establish a more even level of fresh available straw during the day. However, the frequent straw provision did not occupy pigs more than one daily allocation did. In conclusion, there was no difference in penmate-directed behaviour of the pigs when given 25 or 50 g of straw/pig per day compared with 100 g of straw/pig per day, nor were there any difference when 100 g of straw/pig per day was provided more frequently.

Safety effects of permanent running lights for bicycles: A controlled experiment.

Making the use of daytime running lights mandatory for motor vehicles is generally documented to have had a positive impact upon traffic safety. Improving traffic safety for bicyclists is a focal point in the road traffic safety work in Denmark. In 2004 and 2005 a controlled experiment including 3845 cyclists was carried out in Odense, Denmark in order to examine, if permanent running lights mounted to bicycles would improve traffic safety for cyclists. The permanent running lights were mounted to 1845 bicycles and the accident rate was recorded through 12 months for this treatment group and 2000 other bicyclists, the latter serving as a control group without bicycle running lights. The safety effect of the running lights is analysed by comparing incidence rates - number of bicycle accidents recorded per man-month - for the treatment group and the control group. The incidence rate, including all recorded bicycle accidents with personal injury to the participating cyclist, is 19% lower for cyclists with permanent running lights mounted; indicating that the permanent bicycle running light significantly improves traffic safety for cyclists. The study shows that use of permanent bicycle running lights reduces the occurrence of multiparty accidents involving cyclists significantly. In the study the bicycle accidents were recorded trough self-reporting on the Internet. Possible shortcomings and problems related to this accident recording are discussed and analysed.

Confinement of lactating sows in crates for 4 days after farrowing reduces piglet mortality.

To reduce mortality among suckling piglets, lactating sows are traditionally housed in farrowing crates. Alternatively, lactating sows can be housed in farrowing pens where the sow is loose to ensure more behavioural freedom and consequently a better welfare for the sow, although under commercial conditions, farrowing pens have been associated with increased piglet mortality. Most suckling piglets that die do so within the first week of life, so potentially lactating sows do not have to be restrained during the entire lactation period. Therefore, the aim of the current study was to investigate whether confinement of the sow for a limited number of days after farrowing would affect piglet mortality. A total of 210 sows (Danish Landrace × Danish Yorkshire) were farrowed in specially designed swing-aside combination farrowing pens measuring 2.6 m × 1.8 m (combi-pen), where the sows could be kept loose or in a crate. The sows were either: (a) loose during the entire experimental period, (b) crated from days 0 to 4 postpartum, (c) crated from days 0 to 7 postpartum or (d) crated from introduction to the farrowing pen to day 7 postpartum. The sows and their subsequent litters were studied from introduction to the combi-pen ∼1 week before expected farrowing and until 10 days postpartum. Confinement period of the sow failed to affect the number of stillborn piglets; however, sows that were crated after farrowing had fewer live-born mortality deaths (P < 0.001) compared with the sows that were loose during the experimental period. The increased piglet mortality among the loose sows was because of higher mortality in the first 4 days after farrowing. In conclusion, the current study demonstrated that crating the sow for 4 days postpartum was sufficient to reduce piglet mortality.

Reliability of the noninvasive sequence methods to estimate baroreflex function using the paradigm of brain death.

BACKGROUND: Various techniques have been developed to estimate spontaneous baroreflex sensitivity noninvasively. However, in the EuroBaVar study it has been shown that they yield differing results. AIM OF THE STUDY: To investigate the reliability of these methods further we compared the results of the most common sequence techniques. We used the paradigm of brain death with the absence of any baroreflex function. METHODS: In a prospective study we recorded breathing pattern, ECG and continuous blood pressure in 10 consecutive brain dead subjects of a neurointensive care unit. EuroBaVar sequence techniques 12-18 (ST12-ST18) were applied to the data sets and the number of sequences compared. RESULTS: Techniques which are based on thresholds in terms of blood pressure or R-R interval changes yielded the least false positive results: technique ST12, ST13, and ST14 detected very few sequences, while ST18 detected no sequence at all. Techniques using a correlation threshold (ST15-ST17) found a high number. CONCLUSION: This study demonstrates clearly that many of the sequence techniques used to estimate baroreflex sensitivity render false positive results in the unique paradigm of brain death. Thus, the method should be selected with regard to the biological signal and the pathophysiological background.

Peritumoral edema on MRI at initial diagnosis: an independent prognostic factor for glioblastoma?

BACKGROUND: Peritumoral brain edema in glioblastoma patients is a frequently encountered phenomenon that strongly contributes to neurological signs and symptoms. The role of peritumoral edema as a prognostic factor is controversial. MATERIALS AND METHODS: This multi-centre clinical retrospective study included 110 patients with histologically proven glioblastoma. The prognostic impact on overall survival of pre-treatment peritumoral edema detected on MRI-scans was evaluated. All patients had preoperative MRI, surgery, histology, and received standard treatment regimens. Edema on MRI-scans was classified as minor (<1 cm), and major (>1 cm). RESULTS: Our results confirm that peritumoral edema on preoperative MRI is an independent prognostic factor in addition to postoperative Karnofsky performance score (KPS), age, and type of tumor resection. Patients with major edema had significant shorter overall survival compared to patients with minor edema. CONCLUSION: This easily applicable early radiological characterization may contribute to a more subgroup oriented treatment in glioblastoma patients for future trials, as well as in clinical routine.

Idiopathic diaphragmatic paralysis--satisfactory improvement of inspiratory muscle function by inspiratory muscle training.

Daily inspiratory muscle strength and endurance training (IMT) was performed in a 44-year-old patient with idiopathic bilateral diaphragmatic paralysis (BDP) in addition to nocturnal non-invasive ventilation (NIV). After 4 months of training inspiratory muscle function improved satisfactorily whereas phrenic nerve latency remained pathological. Due to the improvement of inspiratory muscle capacity nocturnal NIV could be stopped without inducing nocturnal respiratory insufficiency.

EFNS guidelines on the diagnosis and management of orthostatic hypotension.

Orthostatic (postural) hypotension (OH) is a common, yet under diagnosed disorder. It may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in primary and secondary autonomic disorders. These range from visual disturbances and dizziness to loss of consciousness (syncope) after postural change. Evidence based guidelines for the diagnostic workup and the therapeutic management (non-pharmacological and pharmacological) are provided based on the EFNS guidance regulations. The final literature research was performed in March 2005. For diagnosis of OH, a structured history taking and measurement of blood pressure (BP) and heart rate in supine and upright position are necessary. OH is defined as fall in systolic BP below 20 mmHg and diastolic BP below 10 mmHg of baseline within 3 min in upright position. Passive head-up tilt testing is recommended if the active standing test is negative, especially if the history is suggestive of OH, or in patients with motor impairment. The management initially consists of education, advice and training on various factors that influence blood pressure. Increased water and salt ingestion effectively improves OH. Physical measures include leg crossing, squatting, elastic abdominal binders and stockings, and careful exercise. Fludrocortisone is a valuable starter drug. Second line drugs include sympathomimetics, such as midodrine, ephedrine, or dihydroxyphenylserine. Supine hypertension has to be considered.

Autonomic nervous system laboratories: a European survey.

We present a questionnaire-based survey on methods adopted in European autonomic nervous system (ANS) laboratories in the year 2002. Seventy-nine laboratories from 16 countries in Western and Eastern Europe provided information on test methods, equipment, staff, educational programme and research activities. The results confirmed the anticipated heterogeneity of techniques used to investigate ANS disorders. However, cardiovascular (84.8%) and sudomotor (43.0%) tests were the most common. There were no standards regarding equipment, but devices used varied widely, in part commercially available, in part self-developed. Some ANS laboratories performed cardiovascular tests using standard EMG devices with implemented routines to measure heart rate variability. Many investigators used published normative data (75.4%). Most of the responders were involved in scientific work, half were active in education of trainees. A wide variation was found in number and profession of staff members. As more than 60% of questionnaires were returned by neurologists our results may be limited to neurological ANS laboratories. Given the wide variation of methods and equipment used in European ANS laboratories, minimal standards for routine ANS testing are desirable. Standards may help to compare results of diagnostic tests, evaluate equipment and test laboratory methods and commercial devices and set-up educational programmes.

[Health, growing performance and meat quality of pigs in indoor and outdoor housing--a controlled field trial]. / Gesundheit, Mastleistung und Fleischqualität von Schweinen in der Stall- und Freilandhaltung--ein kontrollierter Feldversuch.

The purpose of the study was to compare indoor and outdoor housing of pigs and their influence on animal health, growing performance and meat quality in a controlled field trial: 29 litters (252 piglets) from indoor and 22 litters (221 piglets) from outdoor were separated at weaning. One half of each litter changed to the opposite housing resulting finally in 4 types of housing: Continuous outdoor or indoor raising and combined outdoor-indoor or indoor-outdoor raising. Pigs in continuous resp. predominant outdoor housing showed lower morbidity and mortality during all raising periods, more active behaviour, higher daily weight gain in weaned pigs and in fattening pigs, but higher feed consumption as compared to indoor housed pigs. However, feed conversion did not differ significantly. Due to climatic influences differences in morbidity were partly more significant in summer litters (intestinal infections) or in winter litters (lung infections). Outdoor pigs raised in summer resulted less often in meat classification E (lean meat percentage > 55%), however, meat quality, estimated by pH-measures did not differ significantly. We conclude from our findings that outdoor housing of pigs from birth to slaughtering may be a serious alternative to predominant indoor keeping with regard to general welfare and growing performance.

Familial hemiplegic migraine: follow-up findings of diffusion-weighted magnetic resonance imaging (MRI), perfusion-MRI and [99mTc] HMPAO-SPECT in a patient with prolonged hemiplegic aura.

Familial hemiplegic migraine (FHM) is a rare inherited autosomal dominant disorder. Migraine aura may last up to several weeks and then resolve without sequel. We report a 21-year-old male with FHM since the age of 3 years. Diffusion-weighted magnetic resonance imaging (DWI), perfusion-MR imaging (P-MRI) and [99mTc] hexamethyl-propyleneamine-oxime-single photon emission tomography (HMPAO-SPECT) were performed on day 2, when he was somnolent with right-sided hemiplegia, on day 9 when a mild hemiparesis was still present and on day 24 after recovery. The right central region showed normal findings in DWI, whereas P-MRI and SPECT revealed hyperperfusion on day 2, less marked on day 9, and normal findings on day 24. In conclusion, this case report indicates for the first time, by means of SPECT, P-MRI and DWI studies, that even extremely long-lasting migraine aura is not associated with cerebral ischaemia. Therefore, it supports the revised International Headache Society criteria where the term 'persistent' aura is proposed.

[Isolated, unilateral paresis of the phrenic nerve after pneumonia and pleurisy]. / Isolierte, unilaterale Parese des N. phrenicus nach Pneumonie und Pleuritis.

Unilateral diaphragmatic paralysis has many causes. Tumor and trauma are the two most frequent identifiable causes. Infectious processes involving the lung and/or mediastinum may result in temporary or permanent diaphragmatic paralysis. We report the case of an 81-year old man who suffered from right-sided pneumonia followed by a period of several months with exertion dyspnea. Radiological examinations showed an elevated right diaphragm, abnormal restrictive lung function, and impaired diaphragmatic muscle strength. The neurophysiological studies provided evidence of a partial phrenic nerve lesion. We discuss the differential diagnosis of isolated phrenic nerve lesions with particular regard to infections.

Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma.

In a 59-year-old female patient, a World Health Organization (WHO) grade II astrocytoma had been diagnosed 16 years ago, which finally progressed into WHO grade III. Several right frontal neurosurgical resections, local radiation and a local radioimplant had been applied. Despite this long record, she was reported alert with a Karnofsky index of 90% until admission. Within a few weeks she rapidly developed akinetic mutism. Upon admission, computed tomography (CT) scan showed a large cystic right frontal defect and a suggested small tumor recurrence. White matter of the frontal lobe appeared to be translucent and compatible with previous radiation. The severe mental changes were initially attributed to a delayed radiation encephalopathy. Neuropathologically, the white matter of the frontal lobe showed mild elevated cell density consistent with gliosis; however, a tumor recurrence invading the tip of the corpus callosum and invading the entire length both fornices appeared. From the neuropathological findings of massive local tumor recurrence in both fornices, together with the acute clinical onset, it seems unlikely that the sequel of radiotherapy caused akinetic mutism, but the symmetric and severe involvement of the limbic system. We conclude that the rapid progression from a state of alertness to a full clinical picture of akinetic mutism was because of infiltration of both fornices.

Acquired neuromyotonia and peripheral neuropathy in a patient with Hodgkin's disease.

Acquired neuromyotonia is characterized by hyperexcitability of motor nerves resulting in continuous muscle fiber activity. It occurs most often as a paraneoplastic syndrome in patients with cancers of the immune system. Antibodies against voltage-gated potassium channels (VGKCs) have been detected in some patients. Peripheral neuropathy is sometimes present. We report on a patient with Hodgkin's lymphoma in complete remission who developed paresthesias followed by neuromyotonia with bulbar involvement. Peripheral sensorimotor neuropathy was diagnosed electrophysiologically and evidence of axonal degeneration and demyelination was detected by sural nerve biopsy. The patient's complaints, including dysarthria, improved after carbamazepine treatment.

Feedback-controlled negative pressure ventilation in patients with stable severe hypercapnic chronic obstructive pulmonary disease.

BACKGROUND: In recent studies, the efficacy of intermittent rest of the inspiratory muscles as an option of treating patients with severe chronic obstructive pulmonary disease (COPD) has become questionable. OBJECTIVE: The aim of our study was to analyze the effects of feedback-controlled intermittent negative pressure ventilation (INPV) on stable, but severely hypercapnic COPD patients. METHODS: 21 clinically stable, hypercapnic patients with severe COPD underwent INPV with chest shells for 3 weeks, 6 h a day. The INPV sessions were optimized by a visual biofeedback system, which enabled control over the decrease in diaphragmatic activity. Respiratory muscle (RM) function parameters, lung function parameters, blood gases and exercise capacity were analyzed. RESULTS: In the end, 19 patients concluded INPV treatment. They had PaO(2) of 56.5 +/- 11.8 mm Hg, PaCO(2) of 50.2+/-2.7 mm Hg (mean +/- SD) and FEV(1) of 27.8 +/- 4.3% predicted before treatment. There was no statistically significant change in lung function parameters, RM function parameters, physical performance and level of dyspnea after 3 weeks of INPV. CONCLUSION: We conclude that intermittent RM rest induced by INPV can relax inspiratory muscles in most patients with stable severe COPD, but fails to improve RM function and exercise capacity.